Chapter 10: Depression in bereavement

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Depression is

a prolonged period with

i) an emotional inclination or mood ranging from a slight sadness to utter misery;

ii) usually accompanied by physical or psychological symptoms.

Different types of depression

The professions sometime argue about, reactive depression after some event as distinct from endogenous depression engendered by chemical changes in the brain.

Symptoms of depression

These are listed on the following note. Three or four of them might indicate depression

Depression and thoughts of suicide

Many depressed people consider suicide, some make the attempt;

it is said that the danger from suicide is greatest as the depression begins to lift;

not all suicide thoughts stem from depression.

Comparison with grieving

Comparisons are listed on an enclosed sheet.

Practical issues

If a bereaved person is feeling very low and despairing then they usually need support to help them lift themselves back to competence.

If they are depressed, then medication needs to be considered, and they may need to be encouraged to go to their GP.

This is an important distinction; it needs hard thought and discussion with your supervisor.

If there are signs that they might be suicidal, then the procedure suggested earlier should be used.


18 pointers to Endogenous Depression

  1. Seemingly irrational statements or answers to questions.
  2. Changes in personality or behaviour patterns.
  3. A continuous change in mood towards depression.
  4. Changes in sleep patterns, usually waking early in the morning.
  5. Worst depression usually in the morning, say between 5 and 6 am.
  6. Nightmares.
  7. Apathy, lack of zest, pessimism.
  8. Loss of concentration.
  9. Loss of appetite and sometimes weight.
  10. Loss of previous interests and motivation.
  11. Loss of sexual urge.
  12. Loss of religious faith.
  13. Anxiety and sometimes agitation.
  14. Feelings of inferiority, uselessness and hopelessness.
  15. A feeling that no-one else is, or can be, interested in you.
  16. A general slowing of thinking and activity.
  17. Suicidal thoughts
  18. A family history of depression.

Differences between depression and grieving

The following are notes taken from Pages 206 and 207 of 'Treatment of Complicated Mourning' By Therese A. Rando

1. Grief lacks the persistent, severe, distorted, and negative perceptions of self, personal experiences, the world, and the future (i.e., hopelessness) that are    typical of depression.

2. Grief tends to be transient and to occur earlier rather than later in the process. In a depressive disorder,  the depression tends to persist and often occurs after a delay in grief.

3. Guilt in grief is relatively more often focused upon some specific aspect of the loss. In depression, the mourner experiences more of an overall sense of culpability, in which there is a preoccu­pation with one's badness, omissions or commissions, and worthlessness.

4. In grief, the loss is most often recognized and acknowledged; in depression, loss is often unrecognized and denied.

5. Grief is not humiliating or demoralizing, whereas depression is.

6. Suicidal gestures are rarely, if ever, observed in uncomplicated mourning but are not atypical in depression.

7. In grief, identification functions for healing and growth. In depression, it functions as a defense.

8. In grief, the individual mourns healthily; in depression, because there is usually no acknowledgment of the loss and grief is defended against, the person does not mourn.

9. In grief, pain is an acknowledgment of the loss, whereas in depression, pain is experienced as useless or meaningless

10. In grief, there is more overt expression of anger than in depression.

11. Grief, as opposed to depression, is characterized by more fluctua­tion in mood and psychological reactions, along with more vari­ability in activity levels, communication, appetite, cognitive, social and physical functioning.

12. In grief, preoccupation tends to be with the deceased, who also tends to be the focus of any hallucinations or delusions. In de­pression, preoccupation appears to be with the self, and any hallucinations or delusions tend to be congruent with depression, pessimism, and poor self-esteem.

13. The mourner can often respond healthily and constructively to warmth, encouragement, and support; the depressed individual typically cannot.

14. The mourner elicits sympathy, concern, and a desire to embrace, whereas the depressed individual frequently elicits irritation, frustration, and a desire to avoid.

Continue to Reflections on Chapter 10